The Secret to Pain Free Breastfeeding

The Breastfeeding Help Video Compilation By Australian International Board Certified Lactation Consultant Kate Hale is full of useful information about breastfeeding and how to manage low supply. It is very clear and concise in its content. It also has a lot handy tips for new mothers, including how to bath, massage and dress an infant. Learn how to care for a new-born, including how to deeply latch your baby and breastfeed without pain within minutes for a contented baby and an end to sore nipples. It is the only Dvd of which I am aware that is readily available to new mothers with an actual demonstration on how to correctly latch a baby on and off the breast using a couple of alternative feeding positions. Reading about breastfeeding in a book is nowhere near as useful as watching the Dvd. Read more here...

Even though the act of breastfeeding seems self-evident and natural, cultural- and art history demonstrates that over the course of times people have always had great respect for this form of feeding and mothering an infant. The world's oldest existing bronze statuette, created by the Hethiters (Anatolia), shows a mother nursing her child. According to Greek mythology, the galaxies formed when milk (gr. jaXa) sprayed out from the breasts of Hera, the wife of Zeus, over the heavens. Old Egyptian Goddesses were often represented breastfeeding their sons. In Roman mythology, not even Bacchus was fed with wine but with the milk ofthe Nymphs. In Christian art, Virgin Mary is shown many thousand-fold as mother with child or Mater galaktotrophousa. The depiction ofthe breastfeeding Mary on the flight to Egypt is particularly popular. This scenery impressively radiates protection, rest, warmth and safety for the child in a harmful and threatening environment.

We often assume that nearly all children were nursed by their mothers in earlier centuries. Unfortunately, this is merely an assumption or an idea but not a fact. Obviously, it is very difficult to know for sure what the situation was in earlier times. We have no statistics or medical descriptions from those times - infant feeding was not yet a topic of medical interest - and customs varied widely in different countries and over different time periods. In some regions mothers breastfed 80 or 90 oftheir infants, mainly the two or three first-born children of the family 21 in other regions, like Bavaria, Tyrol, the Lausitz, Iceland, or cities, like Moscow, breastfeeding had nearly died out for several centuries 3. Until the late 18th century, it was the social norm for upper and middle class mothers to employ wet-nurses rather than breastfeed their infants themselves. In the regions quoted above, however, infants were not breastfed at all. Particularly here in Southern Bavaria, they...

As already mentioned above, at the end of the 19th and the beginning of the 20th century, breastfeeding once again became popular in most European countries (Fig. 5 a + b). Common people now recognised that breastfed children throve better. The reduction of fertility associated with increased breastfeeding, on the other hand, lead to significantly smaller families. Mothers had more time to look after their infants and to nurse them themselves. The inverse correlation between breastfeeding rate and the number of children is obvious (Fig. 6) although there certainly are other contributing factors. Fig. 5 The first renaissance of breastfeeding, starting at the end of the 19th century a) Munich low breastfeeding rate b) Baden high breastfeeding rate This first renaissance of breastfeeding lasted until the end of the thirties. Paediatricians and nurses supported the enthusiasm of young mothers. In St. Gallen - my birth place-, for instance, the breastfeeding rate rose from 58 to 97 between...

Key words breast-feeding, overweight, obesity , prevention Abstract The impact of breast-feeding on overweight and obesity in children at school entry was assessed in a cross sectional study in Bavaria in 1997. The school entry health examination enrolled 134577 children. Data on early feeding were collected in two rural districts (eligible population n 13.345). The analyses were confined to 5 or 6 year old children with German nationality. The main outcome measures were overweight (BM1&gt 90th percentile for all German children seen at the 1997 school entry health examination in Bavaria) and obesity (BM1&gt 97th percentile). Information on breast-feeding was available for 9206 children of whom 56 had been breast-fed for any length of time. In non breast-fed children the upper tail of the BMI distribution was enlarged as compared to the breast-fed children whereas the median was almost identical. The prevalence of obesity in children who had never been breast-fed was 4.5 as compared...

This was the title of the key note presentation of the first author at our Conference in Oaxaca 1986. At that time we reviewed the data from our studies of the mode of feeding in Pakistan illustrating all the problems with delayed onset ofbreastfeeding, consistent addition of other foods and fluids before and during breastfeeding (prelacteals) with a heavy exposure to various microbes in early life as a consequence74. On the basis of our findings we instituted in one village with a population of 6500 a breastfeeding motivation campaign as part of a health care program. After 3 years we have evaluated some of the outcomes. The results were striking with a 50 reduction both in the prevalence of diarrhoea and in infant mortality (Ashraf, Zaman, Jalil et al, unpublished results). Previously all children were given prelacteals like cleared butter, a herb concoction, sugar or salt water etc. and only 50 ofthe children had had any breastmilk at 48 hours after delivery74. After the motivation...

Key words Breast-feeding, Coeliac disease, Epidemiology, Gluten, Prevention Abstract Coeliac disease, or permanent gluten sensitive enteropathy, has emerged as a widespread health problem. It is considered an immunological disease, possibly of autoimmune type, albeit strictly dependent on the presence in the diet of wheat gluten and similar proteins from rye and barley. There are reasons to believe that the aetiology of coeliac disease is multifactorial, i.e. that other environmental exposures than the mere presence in the diet of gluten affect the disease process. Our studies have shown that prolonged breastfeeding, or perhaps even more important, ongoing breast-feeding during the period when gluten-containing foods are introduced into the diet, reduce the risk for coeliac disease. The amount of gluten consumed is also of importance in as much as larger amounts of gluten-containing foods increase the risk for coeliac disease, while it still is dncertain if the age for introducing...

Based on observations of coeliac disease patients it was suggested as early as the 1950s that breast-feeding delays onset of the disease,29 a view later supportedby other similar studies.30,31 National ecological studies comparing changes in exposure and disease occurrence over time in groups ofindividuals considered to be representative of the country's population at large have resulted in contradictory findings. An increase in breast-feeding was suggested as a possible contributing factor in the decline in incidence in England, Scotland and Ireland in the early 1 970s.22-24 In the Netherlands, however, an increase in breast-feeding paralleled a recent increase in incidence.32 Furthermore, a four-fold increase in incidence in Sweden in the 1980s was paralleled by unchanged breastfeeding habits.21 Italian case-referent studies concluded that increased duration ofbreast-feeding was associated with decreased risk for coeliac symptoms.33- 34A protective effect of prolonged breast-feeding...

A major finding in the two larger Swedish case-referent studies was the significant protective effect of introducing gluten containing foods while breast-feeding was still ongoing,1435 and in the former study this effect remained after adjustment both for age at introduction of dietary gluten and for quantity of gluten consumed during this period (to be published). In the Swedish family study based on silent disease this was not confirmed.36 However, the latter study was small (8 cases) and the referents were siblings ofthe cases, with the risk ofmatching for dietary habits.

Key words child growth, breastfeeding, complementary feeding, second year, prospective cohort study Abstract Research has not provided unequivocal support for the recommendation to continue breastfeeding until children reach at least age 24 months. In many circumstances, breastfeeding duration is chosen or conditioned by factors other than scientific evidence and recommendations. Even in communities where breastfeeding into the second year is the nom, a significant number of toddlers are weaned before the recommended age. The research reported here was conducted in a rural community of western Kenya. We prospectively followed a cohort of 264 children for 6 months (mean age at baseline, 14.1 2.4 months) to examine the effect of variable breastfeeding duration on length and weight gain. We found that breastfeeding was positively associated with growth in a manner that we inferred to be causal, the effect being stronger on linear growth than on weight gain. This was despite the fact that...

According to a study of the relationship between nutritional status, growth and mortality risk in a sample ofmore than 5000 children aged 0-5 years, conducted in the Niakhar study area from 1983 to 1985, breastfed children had significantly lower height-for-age and weight-for-height than weaned children from 18 to 36 months of age.7 Traditional midwives, field workers and mothers of underfives in the area consistently stated that this association between malnutrition and breastfeeding did not surprise them, but that it was due to later weaning ofmalnourished children (K. Simondon, unpublished observations). In order to test this statement, a retrospective analysis of factors associated with age at weaning was conducted in a sample of 4515 children, who were born from 1989 to 1995 and had attended vaccination sessions from 1990 to 1996.26 Duration of breastfeeding was analyzed using Cox's proportional hazards models, because about 20 ofthe sample was right-censored, i.e. date of...

Key words Breast feeding, growth, reverse causality, confounding, complementary feeding Abstract The smaller size of breast fed children in infancy and thereafter in malnourished and well-nourished populations has resulted in rushes to judgement that have been shown to be ill-advised. The reasons for the smaller size in malnourished populations is due to retaining the small and sickly child at the breast (reverse causality) and the consequent continuing sickliness of this breast fed child (negative confounding). Once the reverse causality and negative confounding have been taken into account breast feeding improves growth, at least through the second year of life. Thus prolonged breastfeeding should always be fostered, especially in malnourished populations. An exception remains when breast milk may transmit disease to the suckling child. In well-nourished populations the magnitude of the difference between breast fed and weaned children is much less than in malnourished populations,...

Key words Breast feeding, supplementary feeding, pacifier use, randomized controlled trial Abstract It has been shown that altering hospital policies in a way to avoid interference of routine prescriptions with initiation of breast feeding and to provide active encouragement to mothers and personnel can result in significant benefit for later breast feeding success. It is less clear, however, which of the elements of a promotional programme such as UNICEF WHO's ten steps to successful breast feeding are absolutely essential and which can be adapted to local cultural habits. We performed an open randomized multicenter study in Switzerland to evaluate, whether restriction of supplementary fluids for breast fed infants in the first week of life and strict avoidance of artificial teats and pacifiers affects later breast feeding success. Follow up to 6 months was ensured by mailed questionnaires. 602 mother infant pairs were enrolled. Of294 infants in the intervention group 39 were...

In the developing world, a culture ofbreastfeeding exists that does not include the behavior of exclusive breastfeeding. Although the vast majority of women initiate breastfeeding and continue breastfeeding, the duration of exclusive breastfeeding tends to be very short (Table 3). Table 3. Breastfeeding Patterns in Six Latin American Countries DHS Surveys 1994 - 1996 Table 3. Breastfeeding Patterns in Six Latin American Countries DHS Surveys 1994 - 1996 Exclusive Breastfeeding Breastfeeding confers a different health advantage depending on the specific behavior and age of the infant. Exclusive breastfeeding is more protective of health than partial breastfeeding. Within the period of exclusive breastfeeding, benefits are larger the younger the infant, reflecting the declining risk of death across infancy. In a case-control study on breastfeeding and mortality, Victora et al., showed that compared to exclusively breastfed infants, infants who were partially breastfed had a relative...

Over the course of the centuries, also in profane art, the breastfeeding mother was one of the most frequent motives in drawings, paintings, sculptures and even music (e.g. F.Schubert Lied Vormeiner Wiege). Some of these paintings are rather peculiar, sometimes even of medical interest, as for instance la mujer barbudu (the bearded woman) by Jusepe de Ribera (1591-1652). He was a Spanish painter, born in Valencia, but working mostly in Naples, where he was therefore called lo Spagnoletto (Fig.1). Is it really possible that a woman with such a massive virilization can bear and nurse an infant The painter describes important details in the legend next to the figures Magdalena is a 52-year-old woman from the Abruzzes who has given birth to three children. She became severely virilized at the age of 37 and grew a full and abundant beard. The legend does not mention that she had another child thereafter. She was considered a great miracle ofnature, and Ferdinand, the Vice King ofNaples,...

Abstract Traditional wisdom claims that moderate beer consumption may be beneficial for initiation of breastfeeding and enhancement of breastfeeding success. Here we review the question whether or not there-is any scientific basis for this popular belief. There are clear indications that beer can stimulate prolactin secretion which may enhance lactogenesis both in non-lactating humans and in experimental animals. The component in beer responsible for the effect on prolactin secretion is not the alcohol content but apparently a polysaccharide from barley, which explains that the effect on prolactin can also be induced by non-alcoholic beer. No systematic studies are available to evaluate the clinical effects of beer on induction of lactogenesis, and short term studies have shown a reduced breast milk intake by infants after moderate alcohol consumption of their mothers. It is conceivable that relaxing effects of both alcohol and components of hop might also have beneficial effects on...

Key words Cow milk, colostrum, breast-feeding, food allergy, infant, IgE, transforming growth factor- P1 Breast milk contains many immune factors which compensate for the undeveloped defence mechanisms of the gut of the newborn infant. We studied the effect of supplementary CM feeding at the maternity hospital on the subsequent incidence of CMA, the effects of formula and breast feeding on the subsequent immunologic types of CMA, and the importance of immune factors present in colostrum in the immune responses of infants with CMA. In a cohort of 6209 infants, 824 were exclusively breast-fed and 87 required supplementary milk while in the maternity hospital 1789 received CM formula, 1859 pasteurized human milk, and 1737 whey hydrolysate formula. The cumulative incidence of CMA, verified by a CM elimination-challenge test, was 2.4 in the CM, 1.7 in the pasteurized human milk and 1.5 in the whey hydrolysate group. Among these infants, exposure to CM at hospital and a positive atopic...

By now several studies have provided evidence that breastfeeding provides enhanced protection against infection also for years after the termination ofbreastfeeding49. This has been suggested for otitis media53, respiratory tract infections54 Haemophilus influenzae type b infections55-56, diarrhoea57 and wheezing bronchitis in non-atopic children58, 59, This enhanced protection may last from 3-10 years and the protection seems to be increased foreachweekof breastfeeding. There is also evidence that vaccinations may be enhanced during and after breastfeeding against e.g. BCG60,tetanus and diphteria toxoids and poliovirus vaccines61. However, this effect is not seen against all vaccines whichhasbeen discussed49.

Breastfeeding had a complicated relationship with linear growth. When 12-24 mo data were analyzed together, diet and morbidity jointly modified the association between breastfeeding and growth (p 0.02). Increased breastfeeding was associated with lower linear growth only in children with low complementary food intakes and high morbidity. For example, when these children were breastfed at the 75th percentile value (5.7 breastfeeds d), they had slightly lower length gain (-0.23 cm 3 mo) than their weaned contemporaries. For all other children without the combination of low intakes and high illness, breastfeeding was associated with a slight increase in linear growth thus, the rest of this article will focus on the comparison between children with low complementary foods and high morbidity and all other children. Throughout the second year, when complementary food intakes were above the mean or when food intake was low but diarrheal morbidity was also low (thus representing the non-LDHM...

Information on breast-feeding available n 9,206 The main exposure was exclusive breastfeeding and its duration. The question on breastfeeding was ,,Was your child breastfed. If the answer was yes the further question was For how long was your child exclusively breastfed. The categories offered to answer this question were for not more than 2 months, 3 to 5 months, 6 to 12 months and for more than a year. In order to identify covariables potentially associated with breastfeeding several additional items were considered. These regarded housing characteristics and lifestyle (e.g. the age of the house, child's own bedroom, maternal smoking in pregnancy, spare time spent outside in summer and winter), questions on the child's health (e.g. prematurity, low birth weight,) and questions on diet (time of introduction of solid food, consumption of own cooked food or industrial ready-to-meal products, food bought in health food shops) and explorative questions (never, less than once weekly, once...

There are data to suggest that LF and LF peptides come out in the urine of preterm breastfed infants2526. Milk SIgA antibodies coat the enteric bacteria which are usually the cause of urinary tract infections by entering the urinary tract from below. The anti-adherence effects of these antibodies may help preventing such a course. Breastfed infants also have a higher level of oligosaccharide receptor analogues in the urine thannon-breastfed27-29. Furthermore, breastfeeding may result in a selection of less virulent bacteria in the gut 30-32. All these factors may help explaining how breastfeeding can protect against urinary tract infections33'34. Using experimental colitis in mice as another in vivo model we could also show protective effects of LF36 .Thus there were significant effects delaying the appearance ofblood in the stool (p&lt 0.001) and macroscopic bleedings from the rectum (p 0.008). The length ofthe colon was not reduced in the LF treated group as in the untreated...

During breast-feeding the infant will suckle not only milk, but also bacteria on or around the nipple. Thus, the infant swallows typical skin flora bacteria, such as Staph. epidermidis and Staph. aureus. Such bacteria are also found in banked mother's milk32. Conversely, the bottle fed infant may ingest In some studies, breast-fed infants have lower counts of enterobacteria than bottle-fed infants, but more consistently they have less enterobacteria other than E. coli, e.g. Klebsiella, Enterobacter and Citrobacter, as compared with bottle-fed infants. Breast-fed infants also have fewer E. coli strains at a certain time point and over a period of time as compared with bottle-fed infant33-35. Among E. coli strains, those expressing type 1 fimbriae with mannose-specific adhesins seem to be selectively favoured in the suckling infant36- 37while E. coli with adhesins conferring mannose-resistant hemagglutination and P-fimbriated E. coli are disfavoured by breast-feeding35' 38 . There are...

Key words Asthma, breastfeeding, infant feeding practices, wheezing, childhood, epidemiology Abstract The relation of infant feeding to childhood asthma is controversial. This study tested the hypothesis that maternal asthma alters the relation of breastfeeding to childhood asthma. Questionnaires were completed at age 6, 9 or 11 years by parents of 1043 children enrolled at birth. Active MD asthma was defined as a physician diagnosis of asthma plus asthma symptoms reported on one of the questionnaires. Duration of exclusive breastfeeding, categorized as never, &lt 4 months, or &gt 4 months, was based on prospective physician reports or questionnaires completed at 18 months. The relationship between breastfeeding and asthma differed by maternal asthma status. For children with maternal asthma, the percent developing active MD asthma increased significantly with longer duration of exclusive breastfeeding. Odds of developing asthma among these children were significantly elevated (OR...

Comparing English coeliac disease patients in the 1950s and 1960s, respectively, it was suggested that earlier introduction of dietarygluten resulted in earlier presentation ofthe disease.40 However, in clinical studies which also took differences in breast-feeding duration into account, no relation was found between age at introduction of dietary gluten and presentation of disease.30,31

Results based on this ecological approach must, ofcourse, be interpreted with caution, as they are not based on exposure data and disease risk on an individual level. The findings are, however, compatible with the epidemic being a result, at least in part, of a change in and interplay between age at introduction of gluten, amount of gluten given, and whether breast-feeding was ongoing or not when gluten was introduced. Other factor(s) may also have contributed, and the search for these should be encouraged.

The median duration ofbreastfeeding was 19.5 mo. Seventy percent of children breastfedbetween 12-15 mo, dropping to 41.3 between 21-23 mo. Among those toddlers who continued to breastfeed, the feeding frequency was about two feeds day lower at 21-23 months then during the 12-14 mo period.

The relationship between breastfeeding and linear growth in the Peruvian context is complex and fluid. The observed lower growth rate in breastfed children from 12-20 mo can be explained by reverse causality. Mothers purposefully continue to breastfeed children with the poorest health conditions and wean those who are healthier. At the end ofthe second year, child health has a reduced influence on weaning decisions. At this older age, a strong positive effect of breastfeeding can be noted in those children who have the poorest health. It is not surprising that the negative association indicating reverse causality disappears at the end of the second year in the Peruvian data. We have reported elsewhere that, by 24 months, maternal breastfeeding decisions are more closely tied to maternal needs rather than child needs.14 There is now sufficient evidence from the Peruvian study and other published studies, to accept reverse causality as the explanation for a negative relationship between...

Although reverse causality seems to exist in a variety of settings, more knowledge is needed about the reasons for the relationship between the child's nutritional status, health and duration of breastfeeding. Is weaning child-driven or mother-driven Are child characteristics more or less important than mother's characteristics, and which child characteristics are important formothers' weaning decisions milestones (walking, complete dentition) and good appetite for family food, and mother-centered reasons, such as illness, Islamic fasting during Ramadan and desire for a new pregnancy, seemed important.30 However, in periurban Guinea-Bissau, the effect of illness on the duration of breastfeeding was ambigious.31 Most children were weaned because they were healthy or old enough (67.6 N 945), while a few were weaned because of child illness (7.3 ) or maternal illness (9.0 ). The last two groups were weaned significantly earlier than the former (medians of 19 and 18 months, respectively,...

In a study from Finland, the linear growth velocities of exclusively breastfed infants were compared to a group ofinfants breast-fed for less than 3.5 months1. The number ofexclusively breast-fed infants studied were 116 at 6 months, 36 at 9 months, and 7 at 12 months. Linear growth velocity was slower in breast-fed infants at 3 to 6 months, 6 to 9 months, and 9 to 12 months. It is interesting that linear growth was different already during the 36 months period, but not surprising that exclusive breast-feeding beyond 6 months is associated with reduced growth velocity. There is now agreement that breastfed infants should start complementary feeding not later than six months, as prolonged exclusive breastfeeding is likely to result in suboptimal nutritional status, especially regarding zinc, iron and protein. Indeed there were signs of protein deficiency, with lower prealbumin values among breast-fed infants in the Finnish study, and a few of the infants showed catch-up after...

Babies are at risk ofHIV-1 infection while in utero, during delivery and postnatally through breastfeeding. In non-breastfed infants, most MTCT of HIV takes place during the intrapartum period. In breastfeeding populations, 30-50 of the overall transmission is attributable to breastfeeding (Van de

Several studies have demonstrated the presence of cell associated and cell free HIV-1 in breastmilk (Nduati et al. 1995, Van de Perre et al. 1993, Ruff et al. 1994, Guay et al. 1996, Lewis et al. 1998). Two studies have documented an association between breastmilk HIV and infant HIV infection. In the earlier Rwandan study, HIV-1 DNA in day 15 milk was associated with a five fold increased risk of infection in the infant (Van de Perre et al. 1993). A recent study in Malawi, women who transmitted HIV-1 through breastfeeding to their infants had significantly higher plasma and breastmilk viral load (Semba et al. 1999). In this study women who transmitted HIV-1 through breastmilk had a median breastmilk viral load of 700copies ml compared to &lt 200 copies ml among women who did not transmit. A number of studies have reported on the association between mastitis and breastfeeding ((Semba et al. 1999, John et al. 1999, Van de Perre et al. 1992, Ekpini et al. 1997). Most of the early studies...

Abstract Subclinical mastitis, as diagnosed by an elevated sodium potassium ratio in milk accompanied by an increased milk concentration of the inflammatory cytokine, interleukin-8 (IL8), was found to be common among breast feeding women in Bangladesh and Tanzania. Subclinical mastitis results in leakage of plasma constituents into milk, active recruitment of leukocytes into milk, and possible infant gut damage from inflammatory cytokines. Therefore, we wished to investigate whether subclinical mastitis was related to known risk factors for postnatal mother-to-child HIV transmission, that is, high milk viral load or increased infant gut permeability. HIV-infected South African women were recruited at the antenatal clinic of McCord's Hospital, Durban. Risks and benefits of different feeding strategies were explained to them and, if they chose to breast feed, they were encouraged to do so exclusively. Women and infants returned to the clinic at 1,6 and 14 weeks postpartum for an...

On the basis ofthis policy, it became possible to develop Guidelines for Decision Makers and A Guide for Health Care Managers and Supervisors, which had universal applicability. These were issued in 199812, and sought to clarify the direction for implementation, as well as to identify gaps in understanding, and unresolved questions that required further research. There were many serious underlying concerns. While it was recognised that breastfeeding can transmit HIV to an infant, the exact risk of transmission remained uncertain, and appeared to vary with a number of factors including the mother's health and viral load, the condition of her breasts and of the infant's oral and intestinal mucosa. Artificial feeding of infants was also recognised to have serious risks, particularly in those countries most severely affected by the HIV epidemic. The term replacement feeding was coined to refer to alternative feeding of an infant of an HIV-positive mother, to draw attention to the need for...

In 1998, following the demonstration that various short courses of anti-retroviral drugs could reduce mother-to-child transmission (MTCT) of HIV, a series of pilot projects for the prevention of MTCT were launched by WHO, UNICEF and UNAIDS. The aim is to explore the feasibility and cost-effectiveness of a package of services, including improved obstetric care, voluntary and confidential counselling and HIV testing (VCT), and short course anti-retroviral regimes. The package includes infant feeding counselling, the use of replacement feeding by mothers who choose not to breastfeed, and follow up and support for each mother's infant feeding decision. Implementation started first in Botswana, CoteD'Ivoire, Rwanda, and Zimbabwe, to be followed by Kenya, Zambia, Tanzania, and Uganda and a number ofother countries.

As a tool to aid implementation of the guidelines, WHO, UNICEF and UNAIDS are collaborating on the development of materials for a 3-day course called HIV and Infant Feeding Counselling7, which aims to provide training for health workers who will counsel women about infant feeding. The course is designed to be used in conjunction with an existing course on breastfeeding counselling8, and to train a cadre ofinfant feeding counsellors who can counsel all women on their choice of infant feeding method, and support them in either breastfeeding, modified breastfeeding or replacement feeding. These materials will reflect the latest understanding, and will be revised and adapted as new information becomes available.

The fatty acid composition ofhuman milk from different countries has a similar pattern. Koletzko et al. reported data from several studies of breastfeeding mothers in Europe and Africa which resulted to have comparable median values and ranges for PUFA composition when expressed as weight percentages 13 This finding is rather surprising if one considers the differences in ethnicity, living conditions and dietary intakes. The major PUFA in human milk is always linoleic acid with a median value of 11.0 and 12.0 wt. in different European and African countries, respectively 13. a -Linolenic acid, about one order of magnitude lower than linoleic acid in human milk, is most times the second major PUFA. The linoleic a -linolenic acid ratio is used for the expression of the n-6 n-3 balance, which seems important since both fatty acid families compete for the same enzymes in their pathways of LC-PUFA synthesis. In the above mentioned report this ratio was similar in different counties and...

In a previously published study with six breastfeeding mothers we investigated repeatedly the metabolism of linoleic acid at 2, 6 and 12 weeks of lactation 2. All women were on omnivorous diets and received an oral dose of 1 mg kg uniformly 13C-labeled linoleic acid with their breakfast. Dietary intakes were documented by 5 day home protocols during the study. Samples of breath and milk were collected over the period of 5 days at defined timepoints and measurements of 13C enrichment of breath CO2 and of fatty acids in human milk performed with isotope ratio mass spectrometry. Without any correction for a dilution of the CO2 that might occur in the bicarbonate body pool we estimated a total of 20 oxidation of the labeled linoleic acid within 5 days after ingestion. Peak enrichments in breath CO2 occurred between 3-5 hours after consumption of the labeled linoleic acid and values close to the baseline were reached at 36 hours. There was no difference in the kinetics and the cumulative...

Prenatally, as well as postnatally through breast feeding, large amounts are transferred from mother to the child. Formula is free of these substances. Considering their potential developmental neurotoxicity, we investigated long term effects of perinatal exposure to PCBs and dioxins on neurological and cognitive development. Given the evidence that PCBs exert oestrogenic effects, and oestrogens are known to suppress lactation, we investigated the effect of maternal PCB body load on lactation performances as well. Methods. A group of 418 infants were followed from birth up to 6 years of age. Half of them were fully breast fed (BF) for at least 6 weeks. Prenatal PCB exposure was measured from cord and maternal blood. Postnatal exposure was reflected by PCB and dioxin levels in breast and formula milk and plasma PCB levels at 42 months of age. Both neurological and cognitive development were taken as outcome variable at 18, 42 months and at 6 years of age. At 18 and 42 months of age...

Lactational exposure to PCBs and dioxins, in contrast to foetal exposure, had no effect on neurological and cognitive development of term infants at age 18,42 and 72 months, despite 4 times higher PCB exposure levels at 42 months in BF children as compared with FF counterparts. In contrast , a beneficial effect ofbreast-feeding on the fluency ofmovement at 18, 42 as well at 72 months of age was found after adjustments for social, obstetric, perinatal, and neonatal neurologic differences. This effect on the quality of movements can be regarded as a reflection of the differentiation of cortex and basal ganglia. In fetuses and preterm infants, fluency of movement has been found to reflect brain integrity and to be a marker of behavioral and cognitive ability at a later age (Prechtl et al 1997). In the same population a favorable effect ofbreast feeding on cognitive development at 18 months, 42 months and at school age was found. These findings points to a favorable effect of breast...

Abstract Synthetic musks are widely used in various consumer products. The identification of nitro musks in human milk in the early 1990s in connection with evidence for cancerogenicity in animal experiments have caused public concern. However, the validity of previously reported quantitative data has been questioned. Polycylic musks have hardly been investigated so far. The present study aimed at providing accurate current data on the occurrence of nitro and polycyclic musks in human milk. Samples from 40 healthy breast feeding mothers were analysed under carefully controlled conditions avoiding secondary contamination. As in earlier studies, among the nitro compounds musk xylene and ketone were the most frequently detected substances. However, much lower concentrations (roughly by a factor of 10) were found (musk xylene median 6.1 ng kg fat). Among the polycylic musks HHCB was found in most samples (median 64 ng kg fat). Scientific knowledge on possible routes of exposure and health...

The results are listed in Table 6in comparison to the studies on Yucheng children and on the North Carolina cohort. Neonatal behavioural assessment (Brazelton scale) in both American studies was negatively associated with maternal serum levels and fish ingestion, respectively. There were no effects ofhigher cord serum PCBs on the PDI score ofthe Bayley test at 5 months in the Michigan study, but a negative association with the Fagan Test for Infant Intelligence was found at 7 months. At four years of age a poorer performance on the McCarthy Scales ofInfant Abilities was associated with higher PCB levels in milk, especially in verbal performance and numerical memory. However, duration ofbreastfeeding was positively associated with performance. At 11 years of age 212 children, 167 from fish eating and 45 from non-fish eating mothers were tested with the Wechsler Intelligence Scales for Children. Children breastfed with milk containing at least 1.25 p,g PCBs glipid, or having had at...

High levels in milk fat are the result of equally high levels in maternal body fat. If one accepts the toxicokinetic model of life time burden of these lipophilic persistent compounds developed by 27 with free equilibration of e.g. dioxins in all lipids of the body, breastfeeding contributes for a limited time span to the body burden. This model results in predictable concentrations of dioxins in body lipids and, at age seven years approximately, in comparable serum levels of both breastfed and non-breastfed children. In comparison, the total PCB intake through breastfeeding for 6 moths at 800 mL day and assuming 3.5 fat content amounts to the values given in Table 8 for different PCB contents in milk fat from various sources (note the different modes for content determination, which make these results not quantitatively comparable ) Table 8. PCB-intake through breastfeedingfor 6 months These values compare well with PCB contents measured in adipose tissue of sudden infant death...

The latter areas were advised by pediatricians not to breast-feed their infants following the disaster), all remaining maternity hospitals and their corresponding polyclinics were considered eligible for inclusion. Most of the maternity hospitals located in large cities (Minsk, Vitebsk, Brest, and Mogilev) are affiliated with several polyclinics. To maximize efficiency, we limited enrollment to mothers whose infants were to be followed at single selected polyclinic affiliated with each of these large maternity hospitals. Within the selected hospitals, mothers were considered eligible for participation ifthey expressed an intention to breastfeed on admission to the postpartum ward and had no illnesses that would contraind cate breastfeeding or severely compromise its success, such as HIV positivity, active hepatitis B, or tuberculosis, coma, respiratory disease requiring mechanical ventilation, life-threatening infection, psychosis, or treatment with radionuclides or cancer...

By early 1998, it became obvious to the Data Center in Minsk that one ofthe study sites, Novopolotsk,' was reporting durations ofbreastfeeding that were far longer, and incidences ofall infectious illnesses that were far lower, than any of the other study sites, be they experimental or control. Because of the strong suspicion that the Novopolotsk follow-up data had been falsified, we conducted an audit of 64 randomly-selected polyclinic charts and maternal interviews (by telephone or in person) in an effort to substantiate this suspicion. The audit compared the occurrence of one or more gastrointestinal infections and two or more respiratory infections according to the audit source (polyclinic chart or maternal interview) and the PROBIT study data forms. For breastfeeding at 3 months, agreement was considered present if the date of weaning in the polyclinic chart or by maternal interview was within 15 days of the date recorded on the PROBIT polyclinic visit forms. The results of the...

Although no suspicion arose with respect to data validity from the remaining 3 1 sites, a routine audit of data validity had been planned at each. The procedure was similar to the audit carried out in Novopolotsk, although on a more modest scale. At each polyclinic, 20 polyclinic charts were selected at random, and the data contained therein bearing on gastrointestinal infections, respiratory infections, and breastfeeding at 3 months data were compared with the data on these outcomes recorded on the PROBIT polyclinic visit forms. Of the 20 audited polyclinic charts, maternal interviews were also carried out in 10. As shown in Table 4, chance-corrected agreement was high for all three outcomes, as shown by the high levels of kappa, and there was no difference in degree of over- or underestimation according to experimental vs control status.

Does the restriction of fluid supplementation and the elimination of any use of artificial nipples and pacifiers during the first 5 days of life in healthy breast fed term infants increase the duration of complete and partial breast feeding The following centers and individuals participated in the study Bern (D. Durrer), Fribourg (F. Besson), Luzern Kantonsspital (G. Schubiger), Luzern St. Anna (F. Auf der Maur), Morges (J.-M. Choffat), Olten (I. H mmerli), St. Gallen (C. Kind), Winterthur (R. H rlimann), Z rich Pflegerinnenschule (P. Baeckert), Z rich Universit tsspital (D. Mieth). Participating centers all had established breast feeding promotion programmes with early initiation, unrestricted rooming-in, restricted use of formula supplements and attending lactation consultants. - 4200g)born to mothers intending to stay a minimum of 5 days postpartum in the hospital and planning to breast feed for at least 3 months were eligible. After obtaining maternal informed consent mother-child...

Gray-Donald et al performed a controlled prospective study of formula restriction on 781 infants in two maternity wards in Montreal, Canada4. In one ward a night bottle of formula was routinely offered, whereas in the other mothers were awakened for breast feeding. Breast feeding rates at 4 weeks (71 vs. 68 ) and 9 weeks (55 vs. 54 ) were not significantly different, but weight loss was slightly but significantly greater in the formula-restrictedgroup (6.0 vs. 5.1 ). Martin-Calama et al have recently published their randomized controlled trial of glucose water supplementation conductedin the maternity hospital of Teruel, Spain5. 180 healthy full term infants were randomized by a procedure not specified in the article to an unsupplemented group and a glucose water group, being offered glucose water if hungry after breast feeding. The actual amount of supplementation in the two groups was not ascertained by the study, but weight, temperature and blood glucose were assessed at regular...

The medline search found no additional study where prohibition of pacifier use was part of a controlled intervention. Observational studies on pacifier use6,7 show consistently an association of early introduction of a pacifier with early discontinuation of breast feeding. Among women still breast feeding, intervals between feeds are greater, when their infants are regular pacifier users6, thus suggesting that pacifier use might decrease milk production by this mechanism. Pacifier use is very widespread however, with 75 at 2 months in Switzerland3, 68 at 6 weeks in Rochester NY, USA6, and 85 at 1 month in Pelota, Brazil7, even in populations with relatively high breast feeding rates. In a very interesting ethnographic study Victora et al examined psychological and behavioural variables associated withpacifier use7. Women who introducedpacifiers to their infants tended to be less comfortable with breast feeding, to show a more rigid breast feeding style, an increased maternal-infant...

In response to concerns about changing breastfeeding behaviors with negative consequences for infant health, a number of national and international initiatives were implemented to promote breastfeeding. Three of these have been particularly important The International Code of Marketing of Breast-milk Substitutes, the Innocenti Declaration, and the Baby Friendly Hospital Initiative. The International Code of Marketing of Breast-milk Substitutes adopted by the World Health Assembly in 1981 and subsequent relevant World Health Assembly Resolutions, collectively known as The Code, provide guidelines for the marketing of breast-milk substitutes, bottles, and teats2. To ensure infant feeding decisions free from the influence of marketing pressures, the Code aims to restrict such practices, including direct promotion to the public. Furthermore, World Health Assembly Resolutions 39.28, passed in 1986, and 47.5, passed in 1994, urge that there be no donations offree or subsidized supplies...

In a detailed questionnaire concerning dietary habits over two days. Italian recommended daily assumption levels of nutrients (LARN) values for breast-feeding (LA) and not breast-feeding (LB) mothers were used for the purpose ofcomparisons. The data collected were processed by Dietosystem software to obtain the daily nutrient intakes.

Our findings strongly suggest that MP is a useful, non-invasive, public health marker of OL. This conclusion is based on the striking consistency observed between the determinants and consequences of low MT and delayed MP in our population. Our data replicate our previous finding that among women planning to breastfeed for at least six months, those with delayed perception ofthe onset of lactation are more likely to discontinue BF sooner than their counterparts with early perception of OL 3. Future studies are needed in different cultures and settings to conclusively validate MP as a marker ofOL.

In Belgium, reality differs greatly from the ideal situation where every infant receives exclusive breastfeeding during the first 4 to 6 months of life. In this study, 67 ofthe infants receive breastfeeding at birth. According to the parents, the decision to breastfeed is made before pregnancy. So, strategies to enhance breastfeeding rate should be targeted at adolescents. Breastfeeding rate declines rapidly and continuously during the first 5 months oflife. Strategies aimed at increasing breastfeeding duration include better lactational support and lobbying for increasing maternity leave for working mothers and or creating more opportunities to combine work and lactation successfully. Weaning foods were introduced before 4 months in 57 of the infants, whereas current guidelines advice to introduce them between 4 and 6 months of life. As parents introduced weaning foods most frequently as advised by health-care workers, these health-care workers obviously need better up to date...

(1) Socioeconomic factors were strongly associated with feeding type decision. Breastfeeding women in this cohort were older, more educated, of higher socioeconomic status, andmarried. (2) Prior maternal andpaternal experiences with breastfeeding influenced a mother's decision to initiate breastfeeding. (a) When socioeconomic status was controlled, breastfeeding mothers' personality traits contrasted with formula-feeders as being more affectionate, friendly, active, optimistic, receptive to emotional experience, and willing to try new activities. (b) Formula feeding mothers contrasted with breastfeeders as being more reserved, less likely to try new activities, less exuberant, less likely to acknowledge feeling states as important, and more skeptical.

The ADI TDI approach implies chronic intake for the whole lifespan, which of course, does not apply to the breastfeeding period. In fact, breastfeeding for 6 months does account for less than 1 of the mean lifespan. Therefore, ADI TDI values cannot be considered an appropriate instrument to adequately evaluate any health risk for infants' development in the context of breastfeeding. However, if daily substance intakes via breastfeeding are calculated to range below or within the ADI TDI, it can be anticipated that any health risk is highly improbable. Mean levels of dioxins in human milk, given as toxic equivalents (TEq) based on international toxic equivalency factors (I-TEF), are also decreasing. However, calculations based on the current residue levels in human milk samples from Germany clearly demonstrate, that the daily intake of babies by far exceeds the TDI of 1-10 pg I-TEq kg body weight, which had been recommended by the former German Federal Health Office 5. At present, it...

In each area the planned sample size was 100 breast-feeding and 100 formula-feeding mother and infant pairs. Eligible women were approached by their midwives or obstetricians. Inclusion criteria were (1) pregnancy and delivery without complications or serious illnesses (2) first or second born infants (3) born at term (37-42 weeks) and (4) white race. In the BF group, we only included mothers who were able to sustain full breast-feeding for at least 6 weeks. In the FF group, formula milk from a single batch was provided (Almiron M2 NutriciaN.V. The Netherlands). In the latter group, children were exclusively fed on formula-milk during the first 6 months after birth. A wide range ofperinatal factors, including maternal age, body weight and height, parity, formal education, dietary intake and smoking habits were recorded. In addition, the maternal pre-pregnancy body weight and height were measured and used to calculate the body mass index (BMI weight kg height2 m ). Data on the number...

By now, it is well accepted that breastfeeding protects against otitis media, respiratory tract infections, gastroenteritis, urinary tract infections, neonatal septicemia and necrotizing enterocolitis17. The SIgA antibodies may play a role in all of these infections, but this has not been formally proven.

The hypothesis tested was whether the BFHI-based intervention is effective in creating sufficient support for breastfeeding mothers and infants (relative to those sites not receiving the intervention) to prolong the duration ofbreastfeeding and, as a consequence, reduce infectious morbidity during the first 12 months oflife. The primary study outcome was the risk of one or more episodes of gastrointestinal infection. Secondary outcomes included the risk of 2 or more episodes of any respiratory infection, 2 or more upper respiratory infections, atopic eczema, and recurrent (&gt 2 episodes) of wheezing the prevalence of any breastfeeding at 3,6,9, and 12 months of age and the prevalence ofexclusive and predominant breastfeeding at 3 and 6 months. Classification ofbreastfeeding as exclusive or predominant was based on WHO definitions45 applied to the cross-sectional infant feeding information at 1, 2, 3, and 6 months. The criteria for gastrointestinal and upper respiratory infection were...

The immune system of the newborn infant is influenced by maternal immunity, both transplacentally and via the breast milk. Thus, there is a close immunological interaction between the mother and her baby during gestation and during the period of breast-feeding, where the mother may provide protective factors and immune modifying components, as well as antigenic stimulation. The precise relation between breast-feeding and infant allergy is poorly understood. Any allergy-preventing effect of human milk, if true, seems to be limited to babies with a genetically determined increased risk for atopic disease36.The capacity to influence infant immunity may also vary between mothers. Breast milk cell supernatants from atopic mothers stimulate higher levels of cord blood IgE secretion in vitro than cell supernatants from non-atopic mothers37. We have recently been able to demonstrate that breast-milk from non-atopic mothers contain higher levels of ovalbumin-specific secretory IgA antibodies...

Breast-feeding seems to protect very efficiently against translocation51-54. The most important mechanism is probably that milk secretory IgA coats the intestinal bacteria whose translocation is thereby prevented55. Thus, supplementation of formula by secretory IgA from rabbit milk abrogates translocation56, 57, while neither IgG nor lactoferrin has any effect57. Other mechanisms may, however, contribute, since the breast milk contains such an endless array of components with the capacity to influence gut function. For example, epidermal growth factor, which is present in human milk, was shown to significantly decrease bacterial translocation when administered to newborn rabbits together with formula58. Peroral treatment with IL-6, a cytokine present in the breast-milk protects mice from translocation59.

Breast-feeding, current feeding practices, and factors which potentially could influence breast-feeding duration. The ongoing study is carried out in the capital Vilnius. Infants are followed from birth to 12 months with home visits at 3, 6, 9 and 12 months. At each visit the mother is asked about breast-feeding and when complementary foods were introduced. We present data for the first 165 infants who turned 6 months old before September 1999. Breast-feeding rates in 1991 92and 1998 99are compared in the figure. The rates are not very different except for some longer duration of almost exclusive breast-feeding (i.e. infants drinlung water tea juice in addition to breast-milk) during the first 3 months in 1991 92.No data are available on exclusive breast-feeding in 1991 92. Figure 1. Breast-feeding rates in 1991192 and 1998199. (The three solid lines (the 1998 99 study) divide the infants into exclusively, almost exclusively, partially and not breast-fed. The two dashed lines (the...

Milk's nutrients and energy intakes at 1 and 3 mo were not significantly different (p&gt 0.05) respect to area and age (Table 1). Fat breast-milk from mothers in N region was higher (p&lt 0.05) than in C region with 46 and 50 mg mL vs 29 and 31 mg mL, at 1 and 3 mo, respectively. At 3 mo, energy intake from fat and body fat were higher (p&lt 0.05) in the infants of the N region and the higher fat content ofmilk was correlated to a higher mother's body fat (r 0.48, p&lt 0.001). There were no differences in Z score values for weight length (p&gt 0.05) for infants in the two regions at 3 mo. Weight length Z score for infants in N region, at 2 and 3 mo were above +1 compared to ranging between 0 and +0.5 for infant in C region. Mothers in N region are able to breastfeed their infants longer than mothers in C region due to their higherbody fat content (31 vs 25 ,respectively) at 3 mo postpartum.

Abstract This paper summarizes the objectives, design, follow-up, and data validation of a cluster-randomized trial of a breastfeeding promotion intervention modeled on the WHO UNICEF Baby-Friendly Hospital Initiative (BFHI). Thirty-four hospitals and their affiliated polyclinics in the Republic of Belarus were randomized to receive BFHI training of medical, midwifery, and nursing staffs (experimental group) or to continue their routine practices (control group). All breastfeeding mother-infant dyads were considered eligible for inclusion in the study if the infant was singleton, bom at 237 weeks gestation, weighed &gt _2500 grams at birth, and had a 5-minute Apgar score &gt _5, and neither mother nor infant had a medical condition for which breastfeeding was contraindicated. One experimental and one control site refused to accept their randomized allocation and dropped out of the trial. A total of 17,795 mothers were recruited at the 32 remaining sites, and their infants were...

The cultural - and scientific -history of the past centuries was often surrounded by a haze of superstitious imaginations and beliefs. Until the middle of the 18th century, for instance, breastfeeding an infant during the first three days of life was not allowed not only because children first had to be baptised in many regions, but also because colostrum was thought to be harmful to the infant and not compatible with meconium 3. For this reason, different purges were in use to remove the meconium from the stomach and intestines, while the mother's valuable first milk was withdrawn or even sucked off by whelps. With regard to fluids, there still are some controversial ideas which I will not discuss in detail. UNICEF's Ten Steps to Successful Breastfeeding are undoubtedly valuable guidelines for hospitals however, some recommendations lack a solid scientific basis, may go too far and do not respect different cultural and ethnic patterns in raising a child. This comment refers mainly to...

Several problems have been experienced in determining the magnitude of breastmilk transmission of HIV. Following infection with HIV, there is a window period in which infection is undetectable using the currently available technology. Therefore it is technically impossible to isolate closely related exposure points, including very early breastfeeding, exposure from intra-partum and late pregnancy transmission of HIV. Published studies of MTCT of HIV-1 also have some fundamental differences. These include among others, differences in the techniques used to determine infant infection status with earlier studies using antibody-based tests and later studies using DNA PCR to document infant infection as well as differences in severity ofdisease in the study population (Ryder 1994). The studies also differed in the duration of follow-up as well as duration of exposure to breastmilk. Babies in developing countries breastfeeding into the second year of life while those in developed-countries...

Human cytomegalovirus can be detected in different compartments of breast milk. Viral DNA has been detected by means of PCR in Supernatants ofhuman milk 14. A detailed protocol for preparation of milk whey and milk cells was used to describe CMV excretion of breastfeeding mothers of preterm infants during lactation 15. The resulting whey fraction is cell free

The most comprehensive data on breastfeeding trends come from 3 nationally representative sets of surveys. The World Fertility Surveys (WFS), conducted throughout the 1970s in many developing countries, measured the duration ofbreastfeeding. More detailed measures of specific breastfeeding behaviors are available from the Demographic and Health Surveys (DHS), which replaced the WFS in the 1980s and continue today. Since the 1980s, the Centers for Disease Control and Prevention (CDC) has also conducted surveys. All 3 surveys use a 24-hour infant feeding recall to assess infant feeding behaviors. WFS only collected data on breastfeeding duration and, therefore, can only be used to compare trends in this specific behavior. DHS and CDC collect data on other breastfeeding behaviors and can be used to compare changes in the duration of exclusive breastfeeding as well as other specific behaviors. Using only those countries for which trend data are available, median durations ofbreastfeeding...

Another crucial question concerns an issue at the end ofthe breastfeeding period for how long is exclusive breastfeeding adequate to satisfy the dietary needs of the young baby. When should we start to introduce supplementaryfoods,the so-called Beikost The same is true for protein requirements. A 5 -month-oldboy with a body weight of 7 kg, receiving 750 ml ofmilk would get exactly 1 g kg day ofprotein which surely would be insufficient at this age. Infants with a long breastfeeding duration are in fact smaller and weigh less, not only at 6 month but even at two or three years 1718 The difference in length, however, is minimal and merely of academic interest however, it might be a sign of a transient sub-optimal nutrition. Since breastfed babies have the same head circumference as formula-fed infants, one could state that breastfed infants have more brain per kg body weight Then again the same brain power with a little bit more bone and muscle mass would certainly not be a...

Data for this report came from the Tucson Children's Respiratory Study (CRS), a prospective longitudinal study ofrisk factors for the development ofasthma in childhood. Healthy newborns (n 1246)and their families, not selected for allergy history, were enrolled at birth from 1980-1984.7 Data on parental characteristics (ethnicity, education, physician diagnosed asthma, smoking) was obtained by questionnaire at enrollment. Infant feeding information was obtained prospectively, from forms completed by physicians at well child visits, and retrospectively, from parent completed questionnaires when the child was 1.6 years old. Prospective data were given priority. Children were categorized with regard to duration of exclusive breastfeeding (never breastfed, breastfed exclusively &lt 4 months, breastfed exclusively&gt 4months). There was no significant relationship between active MD asthma by age 11 and duration of exclusive breastfeeding, as seen in Table 1. However, the association...

A question is whether breast-feeding is protective or if it is early introduction of infant formula that increases the risk for coeliac disease. However, the protective effect of prolonged breast-feeding was also demonstrated in the Swedish setting, where infants were often breast-fed past six months of age.14,35

Among the specific factors described were water use, sanitation facilities and socio-economic status. Breastfeeding status was monitored throughout the study. Breast milk intake in a single 24-hour period was estimated in a sample of50. Observed intakes were regressed on the child's age (months) to estimate the age effect on breast milk consumption. For average breast milk intake in the sample, the regression equation was applied using each child's midpoint age over the period that he she was breastfeeding. The result was weighted by duration of breastfeeding as percent of time follow-up to estimate average breast milk intake during the observation period. Energy and nutrients in breast milk were estimated on the basis of mature milk composition data from sub-Saharan Africa and India.' Mean age at baseline was 14.1 months (range, 9-18 mo). Only 14 children (5 ) in the final sample (n 264) had been weaned (i.e., stopped breastfeeding) before enrolment into the study and 77...

The Copenhagen Perinatal Cohort consists of about 9000 infants born 1959-61 at Rigshospitalet, the main university hospital in Copenhagen. Data on length, weight and head circumference were collected at birth and at 12 months89 . All measurements were done by paediatricians at the hospital. Furthermore, duration ofbreastfeeding (total duration) was recorded at the one year examination. Personal identification numbers have made it possible to collect data from several Danish public registers. Among these data is draft information on all conscripts (only males) which include data on adult height (and IQ). Thus, it will be possible to examine if an influence of breast-feeding on growth during infancy has any effect on adult stature. Data on the relation between linear growth and relevant background variables in males will be published elsewhere. Here we present data on the relation between linear growth during the first year of life and background variables in females from the cohort....

The mean values of the raw data according to breastfeeding group is given in table 2. Interestingly, there was a significant positive association between breastfeeding and birth length with a gradual increase in length with increasing duration of breastfeeding. Despite this, length at 12 months showed the opposite association with a gradual decrease with increasing duration of breastfeeding. The difference in length gain from birth to 12 months was highly significant with infants being breast-fed for less than 1 month growing 2.7 cm more than those breastfed for more than 9 months. Table 2. Birth length, length at 12 months and length gain according to duration of breastfeeding Table 2. Birth length, length at 12 months and length gain according to duration of breastfeeding Duration of breastfeeding Duration of breastfeeding After controlling for the variables in table 1, the difference in birth length between the breast-feeding groups disappeared. However, there were still highly...

A review of the evolution in our thinking on the relationship between breastfeeding and size is instructive. The contribution by Simondon in this volume cites the various authors who have reported a negative association between breastfeeding and baby's size. Initially investigators who were known for their scientific rigor reported this negative association but were careful in their assessment of the implications for recommendations, awaiting further research to clarify the situation. However, a highly publicized report in 1988 (Brakohiapa et al. 1988 cited in Simondon) stated in their summary that , These results indicate that prolonged breastfeeding can reduce total food intake and thus predispose to malnutrition. The possibility ofreverse causality was not considered. Reverse causality refers to the situation when the putative cause and effect relationship are reversed. This was, for instance, the reason for the extremely high association between not breastfeeding (putative cause)...

The major dissimilarities relate to the amount of information that was presented about each study in this book. The Senegal report reported a generally beneficial effect of breast feeding on growth up to 28 months of age. The Kenyan report mentioned that there was a positive association between the duration of breastfeeding and growth The Peruvian report followed the evolution of the negative association between breast feeding and growth through the second year of life - it did not present evidence of a beneficial effect of breast feeding as had the other two. However, that evidence had been presented in a previous publication ( Marquis et al. 1997 b). The Peruvian studies had ethnographic information, which showed the dynamics of decision making that led to reverse causality. Mothers are concerned that prolonged breast feeding weakens them so they stop when their child no longer needs it. In Peru the information presented at this meeting showed that the strength of this preferential...

This study also found a negative association between breast feeding and growth. The longer the baby suckled the shorter it was at one year of age. This, and the above studies, were also comparable in that they were longitudinal, and they sought to take into account confounding and reverse causality. However, they were not comparable in age or in the level of poverty. In contrast to the other studies, this study collected data in infancy. The babies in the Copenhagen study lived in one of the most healthy and well-grown populations ofthe world, and were not stunted at the onset ofthe study, in contrast to the poverty-stricken, unhealthy and stunted children in the other studies. These differences are so profound that one might think that there is nothing to be learned from the other studies as relates to this study. In fact the Copenhagen study is an important representative of many other studies that have shown that breastfeeding duration is associated with decreased growth in infancy...

HIV-infected pregnant women were recruited from the antenatal clinic at McCord's Hospital, Durban, South Africa in connection with a trial of the effect of vitamin A supplementation on mother-to-child HIV transmission. The study showed that vitamin A supplementation had little effect on transmission20 but infant feeding practices were important.2 Exclusive formula feeding was associated with 19 ofinfants becoming HIV-infected by 3 months ofage, exclusive breast feeding for at least 3 months with 15 infection, and breast feeding mixed with other foods with 24 infant infection which was a significantly higher proportion than in the other two feeding groups. The subclinical mastitis study recruited women who were enrolled during the later part of the main study and who elected to breast feed. Women returned to the clinic when their infants were 1, 6 and 14 weeks old for clinical examination, a questionnaire about infant feeding and breast health, a lactulose mannitol dual sugar test of...

The early experience gained in the pilot projects has raised a series of new concerns. It has been found that even when infant formula for replacement feeding is available, many women prefer not to use it, and choose to breastfeed, in many cases because of fear of stigmatisation. There is growing interest in possible ways to make breastmilk and breastfeeding safer. New evidence has become available that anti-retroviral drugs are effective even if women breastfeed3. The feared rebound increase in transmission of HIV during breastfeeding after a short course of anti-retroviral drugs has been shown not to occur. There is also new evidence that exclusive breastfeeding may be less likely to transmit HIV to the infant than mixed feeding4, though this is an observational study and not conclusive. It is postulated that mixed feeding might increase transmission, because of damage to the infant's intestinal mucosa. Mastitis and sub-clinical mastitis, which may affect up to 16 ofmothers, are...

Implementation is urgently needed, and must proceed on the basis of what is known now. However, there are a number of important research questions, relating to both breastfeeding and replacement feeding, answers to which must be sought to guide implementation in future. These include 2. What is the risk of transmission of HIV through exclusive breastfeeding compared with mixed feeding Additional evidence is urgently needed to confirm or refute the early report. 3. What is the acceptability and feasibility of the modified breastfeeding options 4. How effectively does help to ensure a good breastfeeding technique prevent mastitis and sub-clinical mastitis

Participants from each of the experimental maternity hospitals and polyclinics (usually the head obstetrician and head pediatrician, respectively) received the 18-hour BFHI lactation management training course, which was organized by the European Regional Office of the World Health Organization. The objectives of this course were to assist hospitals in transforming their maternity facilities into baby-friendly institutions that implement the Ten Steps to Successful Breastfeeding and to help equip them with the knowledge to make lasting policy changes. Step 10, the establishment ofbreastfeeding support groups to help mothers and infants following discharge from the maternity hospitals, depends on local circumstances, such as the existence of woman-to-woman support groups (e.g., La Leche League), trained community health nurses or lactation consultants, or specialized lactation clinics. Since none of these sources ofbreastfeeding support were available in Belarus, Step 10 focused on the...

Sample size was calculated based on estimates of the proportion of babies breast-fed (partially or exclusively) at 3 months, the effect of the intervention on increasing that proportion, and the effect of breastfeeding duration on reducing infectious morbidity. From a prior Belarussian Ministry of Health survey, we estimated that 50 of women who initially breastfed at the control (non-intervention hospitals) would still be breastfeeding (to any degree) at 3 months. Based on the available evidence concerning the effectiveness of the individual components of the BFHI, we anticipated that the intervention would reduce breastfeeding discontinuation by 3 months from 50 to 35 , i.e., that 65 of mothers exposed to the intervention vs 65 of mothers not exposed to the intervention would still be breastfeeding their infants (to some degree) at 3 months. Three months of any breastfeeding was chosen as the primary basis for calculating breastfeeding prevalence based on the data of Howie et al5 in...

Despite the fact that 95 of the cohort was breastfeeding, the prevalence of stunting at baseline was 48 and that of underweight 37 . If this were a correlational study, it might be concluded that prolonged breastfeeding was negatively correlated with growth. Multivariate analyses that adjusted for confounding factors showed, however, that continued breastfeeding in the second year was positively associated with length and weight gain in the sample. One recalls that the recommendation is to breastfeed exclusively for at least four months, followed by safe and nutritious foods to complement breast milk from about age six months onwards. More than 90 of children in our sample were placed on complementary foods before they were 3 months old. The nutritional implications of premature initiation of Low birth size and infections during infancy may also have contributed to the observed levels of malnutrition. However, in the absence of data on either factor, it is impossible to estimate the...

Breast feeding has a dramatic protective effect against infant septicaemia. As septicaemia might strike 2 ofnewborn infants in a developing country and kill 1 , this disease is second only to diarrhea as a global killer67. Infant septicaemia may result from translocation of intestinal bacteria across the intestinal barrier. Thus, the same bacterial strain has been recovered from blood and feces in cases of septicaemia due to E. coli68 as well as other enterobacterial The extremely efficient protection from septicaemia afforded by breast-feeding is likely to depend primarily on prevention oftranslocation by means ofmilk secretory IgA. Breast-feeding offers significantprotection from gastroenteritis (Table 1). A range of substances could mediate such an effect. Secretory IgA antibodies against many diarrheal pathogens and their toxins are present in the milk. To delineate which types of anti-microbial antibodies of the secretory IgA isotype that afford protection against...

The trial is ongoing so results presented are based on preliminary cross-sectional analysis of an incomplete set. The subsample of women from the main study who were examined for subclinical mastitis did not differ in general from those in the whole study except that women who did not breastfeed at all were excluded. Ofthe 108 infants (only 104 mothers since there were 4 pairs of twins) 26 infants were HIV-infected by 3 months of age. Mixed feeding was associated with increased viral load at 1 week only. The proportions ofbreasts with undetectable viral load were significantly different across groups at 6 and 14 weeks but this was mainly because ofthe high proportion among the small numbers in the breast milk plus water group. IL8 showed the same pattern as viral load andNa Kratio was similar but not statistically significantly different even at 1 week, unlike in our previous cross-sectional study. However, when analysed as proportions in the different Na K categories, there were...

We followed prospectively 6209 healthy, full-tern infants, whose mothers volunteered to participate to the study immediately after delivery.17 Although breast-feeding was strongly encouraged in the 3 hospitals, 5385 (87 ) of the infants required supplementary milk at hospital. According to the month of birth and delivery hospital, these infants were randomly assigned to receive blindly one of 3 study supplements liquid CM formula (Tutteli Valio, Finland) pasteurized human milk (a mixture of milk from multiple donors expressed 1 to 6 months after delivery) and extensively hydrolysed whey formula (Pepti-Junior , Nutricia, The Netherlands). The comparison group comprised 824 exclusively breast-fed infants. The infants were kept in the hospital for a mean of 4 days. When at home, the mothers recorded the infant-feeding regimen daily during the first 8 weeks. They were advised to supplement breast-feeding with CM formula when required and start solid foods at 4 to 6 months of ages. Data on...

There are also concerns about women's access to adequate fuel, water, necessary utensils and time and about the risk of misuse and spillover of infant formula among women who are uninfected or whose HIV status is unknown, with a consequent erosion of breastfeeding. Already in some settings, there appears to be a loss of confidence in breastfeeding promotion initiatives, and a tendency for some women to feed their infants on infant formula when it is not necessary. The guidelines emphasise the need to continue to promote breastfeeding through health education promotions to strengthen the Baby-friendly Hospital Initiative to support early mother-infant contact and optimal initiation of infant feeding, as this is relevant for both HIV-positive and HIV-negative mothers to train infant feeding counsellors in both breastfeeding support and replacement feeding to take measures to implement the International Code of Marketing of Breast-milk Substitutes, to protect both HIV-positive and...

Given the quality of the typical weaning diet in Marachi Central, neither the high prevalence ofmalnutrition (underweight and stunting) nor the positive association between breastfeeding and growth is surprising. The list ofwealth markers in the community and the low average score on the chosen index suggest that the majority of families could not be expected to afford a nutritious weaning diet to replace breast milk in the second year. On the other hand, interactions between breastfeeding and sanitation suggest that when the former must be curtailed, care should be taken to improve sanitation if the potential negative impact of interrupted breastfeeding is to be attenuated.

STDs can be transmitted from a pregnant woman to the fetus, newborn, or infant before, during, or after birth. Some STDs (like syphilis) cross the placenta and infect the fetus during its development. Other STDs (like gonorrhea, chlamydia, hepatitis B, and genital herpes) are transmitted from the mother to the infant as the infant passes through the birth canal. HIV infection can cross the placenta during pregnancy, infect the newborn during the birth process, and, infect an infant as a result of breast-feeding.

Viral transmission from mother to child was originally suggested by epidemiological evidence most mothers of sero-positive children were carriers of the virus and about 30 of the children of sero-positive mothers were themselves sero-positive. Neonatal infection was initially suspected, but surveys of lymphocytes in cord blood from a large number of children born to sero-positive mothers have virtually, but not completely, excluded this possibility. Instead, breast milk was found to be a likely source of transmissible virus. Supporting this, milk taken from seropositive mothers and given to adult marmosets leads to the appearance of antibodies in these monkeys. More direct evidence stems from a practical trial demonstrating that cessation of breast-feeding by sero-positive mothers drastically reduced the sero-conversion rates of their children (see the last section).

The major, natural route of viral transmission is from mother to child through infected T cells in breast milk (Hino et al., 1985). Curiously, mothers with high levels of antibodies to Tax protein transmit the virus to their offspring at a higher rate than do those with low titres of Tax antibodies. It is possible that efficient replication of HTLV-1 would stimulate antibody production at high levels but that the antibodies might not significantly inhibit viral replication. Non-breast-feeding has been examined among sero-positive mothers in Nagasaki City, Japan, to prevent the viral transmission into children. By consent, pregnant women are surveyed for HTLV-1 antibodies those who are sero-positive are encouraged to avoid breast feeding. The trial indicated a drastic reduction in the incidence of sero-positive children, from about 30 to just a few per cent. The success of this trial provides direct evidence for viral transmission through milk and suggests the possibility of...

Y (breast feeding) Occupation If b 1 is the estimate of p then exp(b is the estimated odds ratio associated with The odds ratio associated with Table 3.1 is given by (30X 14) (36X25) 0.4667.This figure also appears in the computer output given in Table 3.2.The coefficient in the model is -0.7621, and the odds ratio (OR) is given by exp ( 0.7621) 0.4667. Thus printers' wives are nearly half as likely to breast feed for 3 months or more than farmers' wives.

At the end of the 3rd week after birth enhancer regulation in the rat's mesencephalon starts working on a significantly higher activity level. This is the discontinuation of breast feeding, the crucially important first step to living separately from the mother (Knoll and Miklya 1995). Weaning is obviously the onset of the developmental (uphill) phase of the individual life of the mammalian organism (Knoll 1994, 2001). The period, characterized by a higher basic activity, lasts until the rat develops full-scale sexual maturity (Knoll et al. 2000).

Radioactive iodine (RAI) cannot be given to a pregnant woman or one who is breastfeeding. If RAI is given to a pregnant woman, it will be taken into her fetus, destroying its thyroid gland and exposing it to unwanted radiation. Likewise, if RAI is given to a woman who is breast-feeding, it will get into her breast milk. If you're breast-feeding, it will take nearly two months for your breast milk to be sufficiently clear of RAI to be considered safe for your child, making it unreasonable to give you radioactive iodine until you've completely weaned your baby.

At the age of puberty or when HRT is introduced, the doctor explains or re-explains to the girl that the ovaries will be unable to produce egg follicles, and that having babies 'in the usual way' is not possible. At the same time the doctor offers the girl and her parents encouraging information about alternative routes to forming a family, for example through in vitro fertilization (IVF) using egg donation or through adoption. One of my medical colleagues emphasizes to her adolescent patients the similarities they have with other young women - namely the ability to carry a pregnancy, give birth and breast feed. She may talk over the pros and cons of using a known or an unknown egg donor even at this early stage, but notes that her patients do not necessarily ask for further details until much later.

If you first develop an autoimmune thyroid disease such as Graves' disease or Hashimoto's disease after you deliver, you would undergo normal treatment for either disease, as outlined in Chapters 5 and 6. If you developed Graves' disease after delivery and are breast-feeding, you may continue breast-feeding while on antithyroid medication but must not breast-feed if you're having radioactive iodine therapy or scans. If you were diagnosed and successfully treated for Graves' disease prior to pregnancy, you can sometimes suffer a relapse after delivery. But depending on the severity of Graves' disease after delivery, some women can opt to postpone treatment until they're finished breast-feeding.

HIV (human immunodeficiency virus) is the virus that causes AIDS. HIV is not transmitted through the air or by eating food. It does not live long outside the body. HIV can be found in the blood, semen, or vaginal fluid of an infected person. In addition, infected pregnant women can pass HIV to their baby during pregnancy or delivery, as well as through breast-feeding.

Fluences the mother-infant bond in humans, although correlational studies suggest that endogenous oxytocin does influence personality traits in postpartum women. Women who give birth by cesarean section have fewer oxytocin pulses during breastfeeding than those who give birth vaginally, and are less likely to describe themselves during the postpartum period as exhibiting a calm personality or high levels of sociality. In mothers delivering by cesarean section, oxytocin levels are correlated with the degree of openness to social interactions and with calmness.

(iii) Being a gentle pathogen requires elaborate controls to self-limit growth. Persistence of a sexually transmitted disease depends, therefore, on growth inhibitory mechanisms in part coded by the virus, but frequently dependent on host function. The host immune system that limits the viremia and viral encoded mechanisms may act to modulate the immune response and act in other ways to control and limit growth. It can be assumed that the lentiviruses of nonhuman primates, such as SIV (Simian Immunodeficiency Virus), are adapted to a low rate of vertical transmission because of the devastating action of many viruses on neonates due to the latter's underdeveloped immune system. HIV is transmitted to offspring in utero, perinatally, or via breast-feeding, but the

To choose the best method of birth control, a person should discuss the following issues with their partner and health care provider their health, age, plans for future children, whether both partners are monogamous, the ability to use a method of birth control every time at intercourse, and for the woman, if she thinks she can take a pill every day. If a woman is postpartum or breastfeeding, there are additional issues and methods she needs to consider when selecting a form of birth control.

Rhythm requires a woman to know the most fertile time of her monthly cycle so that she can avoid intercourse or use another method of birth control during that time. While this method can be effective if used correctly, in actual practice it is frequently less effective. General illness, vaginal infections, breastfeeding and stress can interfere with the monthly cycle or ability to determine her most fertile time. While there are no physical side effects, close cooperation between sex partners is essential.

Maternal-to-infant transmission can occur in utero, during labor and delivery, or postnatally by breast-feeding. y Both the risk factors of mother-to-infant transmission and its timing are under active investigation. In utero transmission before 20 weeks of gestation is well documented. However, current evidence suggests that transmission during the third trimester and at parturition may be most common. y y y y y y y y y y y Ihe rate of mother-to-infant infection is estimated at about 25 percent (range 13 to 45 percent).y Maternal factors reported to be associated with increased risk of transmission include low CD4+ counts, high viral titers, advanced primary HIV-1 disease, AIDS, placental membrane inflammation, premature rupture of membranes, premature delivery, increased exposure of the infant to maternal blood, and low vitamin A.y y y , y , y y y

New Mothers Guide to Breast Feeding

For many years, scientists have been playing out the ingredients that make breast milk the perfect food for babies. They've discovered to day over 200 close compounds to fight infection, help the immune system mature, aid in digestion, and support brain growth - nature made properties that science simply cannot copy. The important long term benefits of breast feeding include reduced risk of asthma, allergies, obesity, and some forms of childhood cancer. The more that scientists continue to learn, the better breast milk looks.